An Examination of Factors That Predict the Perioperative Culture of Safety

Normalization of deviance is a phenomenon in which individuals and teams depart from an acceptable performance standard until the adopted way of practice becomes the new norm. This phenomenon is concerning in high‐risk areas of health care because it erodes a safety culture. Additionally, it is inimical to the principles of high reliability—specifically, to the first of the five principles: preoccupation with failure. Although all high‐reliability principles hold relevance to safety, preoccupation with failure describes a consistent alertness to risk and is critical for preventing adverse events, particularly in high‐risk environments such as the OR. This article describes how normalization of deviance and preoccupation with failure cannot coexist and presents ways to mitigate normalization of deviance and bolster high reliability, ultimately making ORs safer for surgical patients.

Section: Solutionsmentioning

confidence: 99%

Section: Solutionsmentioning

confidence: 99%

Section: Solutionsmentioning

confidence: 99%

See 1 more Smart Citation

Normalization of Deviance Is Contrary to the Principles of High Reliability

Wright¹

2023

“…An engaged perioperative team may help manage OR complexities, and perioperative nurses' work engagement is a significant predictor of a culture of safety in the OR (β = 0.628; 95% confidence interval, 1.578 to 3.126; P < .001). 1 Work engagement also is a facilitator of adherence to safety standards and practices. 2 Strong relationships between perioperative nurses and their managers positively influence work engagement and adherence to OR safety standards.…”

mentioning

confidence: 99%

“…Perioperative areas are complex, multifaceted environments in which patients are vulnerable to adverse events. An engaged perioperative team may help manage OR complexities, and perioperative nurses’ work engagement is a significant predictor of a culture of safety in the OR (β = 0.628; 95% confidence interval, 1.578 to 3.126; P < .001) 1 . Work engagement also is a facilitator of adherence to safety standards and practices 2 .…”

mentioning

confidence: 99%

Factors in the Perioperative Nurses’ Work Environment That Predict Work Engagement

Wright,

Sha,

Hall

et al. 2024

Perioperative nurse engagement and certification are associated with a culture of safety, which is crucial in perioperative environments. Therefore, examining relationships between engagement, the practice environment, and certification is warranted. The purposes of this study were to examine the relationships between the perioperative practice environment and reported nurse engagement, determine differences in engagement based on certification, and identify facilitators and barriers to attaining and sustaining certification. In this multiphase mixed‐methods study, we used a convenience sample of perioperative nurses (N = 379) to examine relationships between engagement, the practice environment, and certification. Qualitative interviews were conducted (n = 15) to supplement the quantitative findings. Leadership support (β = 0.23, P = .001) and nursing foundations for quality care (β = 0.21, P = .01) were significant predictors of engagement. Certified nurses did not have significantly higher mean engagement scores when compared with noncertified peers. Qualitative interviews corroborated the findings.

The Art of Speaking Up: Supporting a Culture of Safety in the OR

Wright,

Kernen,

Kouevi

2024

Considering the high‐risk, stressful, and fast‐paced nature of the perioperative environment and vulnerability of surgical patients, the quest for maintaining a safety culture in the OR is ongoing. Speaking up—an interaction between perioperative team members to address a concern—requires team member empowerment to advocate for patient safety when needed. Hierarchical gradients, lack of psychological safety, incivility, and a nonsupportive organizational culture can impede speaking‐up behaviors. Strategies to improve speaking up include using multimethod education initiatives, enhancing psychological safety, and managing conflict. Perioperative nurses can experience barriers to speaking up, such as lack of team familiarity, normalization of deviance, and differing perceptions among team members. The logistics of whole‐team training initiatives can be challenging; however, such initiatives can help participants improve their understanding of the perspectives and communication goals of all involved personnel. Perioperative nurses and leaders should collaborate to promote speaking up for safety when warranted.